Vertigo: Testing and Treatment for BPPV

Vertigo, specifically BPPV, can bring on significant feelings of anxiety and fear.  So many times, my patients are very nervous and fearful when they come in for their physical therapy evaluation, which actually makes their symptoms of dizziness so much worse.  In many cases, they have already been to the emergency room, doctor's office, ENT, or even a neurologist before getting a physical therapy referral.  They have had many tests run with no significant findings or results.

As discussed in the previous post, BPPV is brought on by sudden position changes and lasts less than 1 minute. However, people can have sensations of motion sensitivity, nausea, or lightheadedness much longer.  It is my goal to reduce anxiety and fear about dizziness before patients even come into the clinic.  BPPV is straightforward to test for and can be resolved in as little as 1 to 2 visits.  

Testing

Let's start with the testing: First, your physical therapist will take your history and discuss all positions or factors that provoke your dizziness. This is actually the most critical part of the examination when it comes to vestibular disorders!  Next, they will perform an oculomotor assessment to see how your eyes move and how they move in relation to your head.  If you have BPPV, this testing will be relatively unremarkable for you. Still, we use it to rule out other disorders.  The primary test for BPPV is called a Dix-Hallpike maneuver, in which you will start sitting on the exam table with your legs stretched out in front of you.  Your physical therapist will guide you to turn your head 45 degrees to one side and to lay all the way back with your head extended slightly off the edge of the table (your therapist will be supporting your head).  The goal of this test is to be dizzy!  You heard me right; if you experience dizziness (room spinning or lightheadedness) in this position, there is a very good chance we can fix the dizziness in this visit.  

The dizziness should not be any worse than what you have already experienced.  The key is to keep your eyes open and try to find something stationary to focus on.  This will allow your brain to get reoriented. If you keep your eyes closed, the spinning sensation can last twice as long.  If this test is negative, the therapist will repeat on the other side.  If both sides are negative, they will try a roll test, which assesses the horizontal canal.  For the roll test, the therapist will have you lay down on your back and support your head slightly flexed up off the table.  They will quickly turn your head to each side, this is not painful, and they do not turn it very far.  

During each test, the therapist will watch your eyes to check for nystagmus, which is another reason to keep your eyes open. The testing will tell the therapist which ear is involved and which canal is causing the problem.  If any of the above positional tests are positive, they will perform the appropriate canalith repositioning maneuver.  

Treatment Maneuvers

I have created a YouTube video to walk you through the most common canalith repositioning maneuver for the posterior canal. It is also referred to as the Epley maneuver.  

It is essential to have the maneuver performed by a qualified healthcare professional. If you attempt to do it yourself, your head may not be in the appropriate position, which can cause the crystals to translate from the posterior canal into the horizontal canal.  If this happens, don't worry,  there is a separate maneuver for the horizontal canal. We can perform this maneuver, but if the crystals are in multiple canals, you may have more intense symptoms, and it may take more maneuvers to correct the problem.

I have more information on my website at: https://movementmatters-pt.com/dizziness-vestibular-therapy or check out this video on my YouTube Channel: Treatment for BPPV: Canalith Repositioning Maneuver - YouTube

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For more information or to find a provider that specializes in vestibular disorders near you, check out: https://vestibular.org 

Disclaimer

This blog is provided for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.